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Cited by 20Health Systems, Economic Evaluations, Quality of LifePublic Health Policies and EducationEvaluation and Performance Assessment

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A cost-benefit analysis framework for preventive health interventions to aid decision-making in Australian governments

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Ananthapavan, Jaithri, Moodie, Marj, Milat, Andrew, Veerman, Lennert, Whittaker, Elizabeth, Carter, Rob·2021·Health Research Policy and Systems
DOI 10.1186/s12961-021-00796-wPMC PMC8684630
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Abstract

BACKGROUND: Australian governments are increasingly mandating the use of cost-benefit analysis (CBA) to inform the efficient allocation of government resources. CBA is likely to be useful when evaluating preventive health interventions that are often cross-sectoral in nature and require Cabinet approval prior to implementation. This study outlines a CBA framework for the evaluation of preventive health interventions that balances the need for consistency with other agency guidelines whilst adhering to guidelines and conventions for health economic evaluations. METHODS: We analysed CBA and other evaluation guidance documents published by Australian federal and New South Wales (NSW) government departments. Data extraction compared the recommendations made by different agencies and the impact on the analysis of preventive health interventions. The framework specifies a reference case and sensitivity analyses based on the following considerations: (1) applied economic evaluation theory; (2) consistency between CBA across different government departments; (3) the ease of moving from a CBA to a more conventional cost-effectiveness/cost-utility analysis framework often used for health interventions; (4) the practicalities of application; and (5) the needs of end users being both Cabinet decision-makers and health policy-makers. RESULTS: Nine documents provided CBA or relevant economic evaluation guidance. There were differences in terminology and areas of agreement and disagreement between the guidelines. Disagreement between guidelines involved (1) the community included in the societal perspective; (2) the number of options that should be appraised in ex ante analyses; (3) the appropriate time horizon for interventions with longer economic lives; (4) the theoretical basis and value of the discount rate; (5) parameter values for variables such as the value of a statistical life; and (6) the summary measure for decision-making. CONCLUSIONS: This paper addresses some of the methodological challenges that have hindered the use of CBA in prevention by outlining a framework that is consistent with treasury department guidelines whilst considering the unique features of prevention policies. The effective use and implementation of a preventive health CBA framework is likely to require considerable investment of time and resources from state and federal government departments of health and treasury but has the potential to improve decision-making related to preventive health policies and programmes.

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  • Missing elements to the implementation of large-scale and long-term prevention strategies are political will and adequate and effective financing and economic evaluation frameworks.

    “Missing elements to the implementation of large-scale and long-term prevention strategies are political will 272 and adequate and effective financing and economic evaluation frameworks. 273”

    From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [273]

    The Background (page not provided) says implementing preventive health policies often requires political support and that existing economic-evaluation methods pose challenges. The Conclusions (page not provided) call for commitment and investment in adopting the proposed evaluation framework. The paper does not establish inadequate financing of large-scale, long-term prevention strategies as a missing element; its resource discussion concerns implementing the framework. (LLM, conf=0.84)

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Metadata

Authors
Ananthapavan, J., Moodie, M., Milat, A., Veerman, L., Whittaker, E., & Carter, R.
Affiliations
  • Deakin University (AU)
  • The University of Sydney (AU)
  • Griffith University (AU)
  • New South Wales Department of Health (AU)
Corresponding author
Ananthapavan, Jaithri
ORCID
Venue
Health Research Policy and Systems
Publisher
Springer Science and Business Media LLC
Published
2021-12
Volume
19
Issue
1
Pages
147-147
ISSN
1478-4505 (ISSN-L)
DOI
10.1186/s12961-021-00796-w
PMC
PMC8684630
OpenAlex
W4200128323
Cited by
20
References
1
Citations by year
2026: 3 · 2025: 5 · 2024: 5 · 2023: 2 · 2022: 5
FWCI
2.29
Type
journal article
Language
en
Open access
Licence
Locations
  • Health Research Policy and Systems (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Deakin Research Online (Deakin University) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Griffith Research Online (submittedVersion, cc-by)
Funders
  • Australian Prevention Partnership Centre
  • National Health and Medical Research Council (APP1152968)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Public Health Policies and Education
  • Social Sciences › Public Administration › Evaluation and Performance Assessment
Keywords
cost-benefit analysis, preventive health measures, government decision-making, health policy evaluation, economic evaluation guidelines, reference case, sensitivity analysis, discount rate, value of a statistical life, societal perspective, time horizon, cost-effectiveness analysis, Australian federal government, New South Wales government
MeSH terms
Australia, Cost-Benefit Analysis, Government, Health Policy, Humans, Preventive Health Services

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